Radiographic Positioning for Cervical Spine

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Questions and Answers

What should a patient's chin be resting against during a Chest PA?

IR

What is the position of the patient's arms during a Chest PA?

The patient's arms should be raised above their head with the elbows flexed, and their palms should be facing outward. The patient's shoulders should be rotated forward to allow the scapulas to move laterally and clear the lung fields. The patient's shoulders should be depressed downward to move the clavicles below the apices.

For a Chest PA, what is the top border of the light field of the IR at the level of?

Vertebra prominens

What is the range of centimeters for the mid thorax IR position in a Chest PA?

<p>7.5-10cm</p> Signup and view all the answers

What is being demonstrated on a Lateral Chest?

<p>larynx and trachea lie anterior to cervical and thoracic vertebrae</p> Signup and view all the answers

What is the position of the patient's arm and shoulder closest to the IR during a lateral Chest?

<p>UP</p> Signup and view all the answers

What is the position of the patient's arm and shoulder furthest from the IR during a lateral Chest?

<p>Down, and slightly rotated posterior</p> Signup and view all the answers

What are the two ways to position the patient for a Lateral Chest?

<p>The patient can be placed in either an upright standing position or a reclined position to the side.</p> Signup and view all the answers

What is the positioning at the top of the IR in a lateral Chest?

<p>The top of the IR should be at the level of the foramen magnum (FAM).</p> Signup and view all the answers

What is the CR positioning for a Lateral Chest?

<p>The center ray (CR) should be at the level of the C6-C7 vertebrae. The CR should be midway between the laryngeal prominence and the jugular notch.</p> Signup and view all the answers

What specific position is the lateral chest used for?

<p>The patient should be in a standing lateral position or reclined lateral position for at least 5 minutes before capture, but if the patient cannot maintain a standing or reclining position due to their condition or health, the lateral chest may be taken.</p> Signup and view all the answers

What is the CR level for an Abdomen view?

<p>The CR should be at the level of the iliac crests. The bottom of the IR should be at the symphysis pubis.</p> Signup and view all the answers

What type of inspiration is preferred for an Abdomen view?

<p>The preferred inspiration for an Abdomen view is a slow, deep inspiration to ensure inflation of the trachea, thyroid cartilage, and upper airway with air. This also allows the outline of the liver, spleen, kidneys, psoas muscles, air-filled stomach and bowel segments, the arch of the symphysis pubis, and obturator foramina to be visualized.</p> Signup and view all the answers

How long should a patient be upright before capture of the Abdomen view?

<p>Patients should be upright for at least 5 minutes, preferably 10-20 minutes, before exposure to capture the small amounts of intraperitoneal air, if present. Hypersthenic patients may require two landscape IRs to capture the entirety of the abdomen.</p> Signup and view all the answers

What is the position of the CR for a Lateral Sacrum and Coccyx view?

<p>The CR should be 8-10 cm posterior to the ASIS (center of sacrum).</p> Signup and view all the answers

What is the position of the CR for a PA Axial Coccyx view?

<p>The CR should be 5 cm distal to the ASIS.</p> Signup and view all the answers

What is the degree of rotation of the body for an RPO or LPO Sacrum and Coccyx view?

<p>The body should be rotated 25-30 degrees for an RPO or LPO view.</p> Signup and view all the answers

Where should the CR be positioned for a PA Axial Sacrum view?

<p>The CR should be positioned 30-35 degrees caudad, with the CR being aimed at L4 or slightly above the iliac crest.</p> Signup and view all the answers

What is the degree of cephalad angulation for a Lateral Sacrum view?

<p>30 degrees for males and 35 degrees for females.</p> Signup and view all the answers

What are the anatomical structures visualized in an RPO lumbar view?

<p>The structures that can be visualized in an RPO lumbar view are the pedicle demonstrated posteriorly on the vertebral body, which indicates over-rotation, and the pedicle demonstrated anteriorly on the vertebral body, which indicates under-rotation.</p> Signup and view all the answers

Flashcards

Departmental option

Turning the patient's head towards the image receptor (IR) to create a near-lateral position. This helps to prevent superimposition of the mandible on the upper vertebrae by rotating the upper vertebrae slightly.

Lateral curvature (Scoliosis)

A sideways curvature of the spine, usually visible when looking at the patient from behind. This type of curvature may require adjustments to the patient's position.

Sag or Convexity

The rounded outward projection of a curved spine, also known as the 'bulge'.

Intervertebral spaces

The spaces between the vertebrae. Placing the patient's spine so the 'sag' (convexity) faces downwards helps to open these spaces for better visualization.

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Interiliac line

An imaginary line drawn between the highest points of the hip bones (iliac crests).

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Secondary or scatter radiation

Radiation that is produced due to the thickness of the patient's body. This type of radiation can cause a higher dose to the patient and reduce image quality.

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Lead masking

A metal shield that is placed to protect the patient from unnecessary radiation exposure.

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Midsagittal plane

A vertical plane that divides the body into left and right halves, passing through the middle of the nose and the chin.

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Old (Object-to-image receptor distance)

The distance between the X-ray source and the image receptor.

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Costophrenic angles

The sharp, pointed angles formed where the diaphragm meets the ribs, visible on chest x-rays.

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Jugular notch

The bony projection at the front of the neck, above the breastbone, a landmark used for positioning chest x-rays.

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Vertebra prominens

The most prominent bony bump on the back of the neck, often used for aligning the patient during cervical spine x-rays.

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Compensating filter

A special filter used with x-rays that compensates for the different thicknesses of the body, ensuring a more uniform image.

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Optional breathing technique

A technique used to blur the images of moving structures like the lungs, allowing for better visualization of the bones during x-rays.

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Cervicothoracic (swimmer's) lateral position

A special x-ray position used to visualize the lower cervical and upper thoracic spine. This position requires the patient to extend one arm forward while bending their other arm backwards, similar to a swimmer's pose.

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CR perpendicular to IR

A technique utilized to adjust the x-ray beam so it is perpendicular to the image receptor. It is critical for ensuring the correct projection of the structures being evaluated.

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Caudad angulation

A technique used to ensure that the x-ray beam is adjusted slightly downwards (caudally) to ensure all structures are properly aligned and visualized. This technique is often used for individuals with a wide chest.

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Laryngeal prominence (C5)

The prominence of the thyroid cartilage, often used as a landmark during the imaging of the neck.

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Larynx and upper trachea

The area around the voice box and upper windpipe, often visualized to evaluate for any abnormalities.

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Upper jugular notch (T1-2)

The space where the neck meets the chest, often used as a landmark during neck and chest x-rays.

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Vertebral bodies

The body of the vertebrae, the main solid mass of the bone.

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Intervertebral disk spaces

The spaces between the vertebrae that contain a soft, spongy tissue called the intervertebral disc.

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Zygapophyseal joints

The bony projections on the vertebrae that connect with the adjacent vertebrae, allowing for movement and support.

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Articular pillars

The bony extensions of the vertebrae that project outwards, allowing for muscle attachment and stability.

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Lateral decubitus

An x-ray procedure used to visualize the abdomen, allowing assessment of organs like the stomach, intestines, and diaphragm.

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Hypersthenic patients

A patient with an unusually large chest, requiring special considerations for imaging.

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Thorax

The area of the body above the abdomen, containing the lungs, heart, and esophagus.

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Stomach

The air-filled organ responsible for digestion and breakdown of food.

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Study Notes

Radiographic Positioning for Cervical Spine

  • PP 1 (Posterior-Anterior): Open-mouth AP projection, supine or erect position. Arm by side. Mandibular angles and mastoid tips are equidistant from the image receptor (IR). Mouth wide open during exposure. CR perpendicular to IR, through center of the open mouth.
  • PP 2 (Posterior-Anterior): Supine or erect position. CR angled 15-20 degrees cephalad for a supine or less lordotic curvature. More than 20 degrees for more lordotic curvature. CR at the level of lower margin of thyroid cartilage to pass through C4.
  • CR (Central Ray): The direction of the central ray (CR) is crucial for proper positioning. Angles and target locations vary significantly based on the position and curvature of the subject.
  • Rotation: Rotating the body and head 45 degrees is used for oblique projections. Positioning aids ensure accurate 45-degree rotation.
  • Chin Elevation: Chin elevation to parallel the floor, is part of the procedure to superimpose the base of the skull over C1.
  • Shoulder Depression: Depress the shoulder to place the top of the cassette 3-5 cm above the external auditory meatus.
  • Respiration: Suspend on full expiration, or maximum shoulder depression.
  • Anatomy Demonstrated: Cervical vertebrae bodies, intervertebral disk spaces, pedicles, intervertebral foramina, articular pillars, spinous processes, and zygapophyseal joints.
  • Support: Proper support of the patient, especially the head and neck, is essential to prevent movement during exposure.

Radiographic Positioning for Thoracic Spine

  • PP1 (Posterior-Anterior): Supine preferred. Anode heel effect considered for uniform density. Flex knees and hips to reduce thoracic curvature. CR 7-10 cm below the jugular notch or 3-5 cm below the sternal angle.
  • Lateral: Lateral recumbent preferred, with knees flexed. Raise patient's arms to high angles, elbows flexed, support waist. Ensure the entire supine body is near parallel to the table.
  • Lumbar: Supine or prone (erect preferred). Flex knees, hips. CR is 7-21 cm below vertebra prominens.
  • Other Positions: Projections vary (e.g., AP, PA, oblique, lateral). Different positions highlight various anatomical details.
  • Respiration: Suspend on full inspiration to get uniform density of vertebra above the diaphragm.
  • Large/Small IR: Larger image receptors (IR) target areas like the ilium crest, while smaller IRs target spaces like the lower costal margin. CR is adjusted accordingly.
  • Special Cases: In scoliosis cases, patients are positioned to showcase the curvature. CR is angled based on the sacrum and pelvis' curvature to optimize the view of intervertebral foramina.

Radiographic Positioning for Other Regions

  • Thoracic positioning: includes supine AP, lateral recumbent, positioning for AP and lateral projections and noting the centering for the different views.
  • Lumbar anatomy: includes the positioning for AP, and oblique views. Notes include adjusting the CR based on visible curvature.
  • Additional Notes: Specifics on support, centering, and exposure based on individual patient attributes are described.
  • Sacrum: A variety of views (AP, axial, lateral, RPO, LPO) are indicated for the radiographic views while considering angles, support, and patient positioning.
  • Coccyx: Views include AP, Axial, and Lateral. Positioning involves aligning the long axis of the sacrum and coccyx to the central ray and the midline of the table/image receptor.
  • Radiographs of the Abdomen: Patient positioning (prone, upright, lateral decubitus) during expiration are described.
  • Scottie Dog Appearance: The Scotty Dog appearance relates to lumbar spine positioning and radiographic analysis
  • Additional Body Parts: Notes on positioning and exposure are provided for various different body parts and regions.

Cervical, Thoracic, and Lumbar Spine Imaging Considerations

  • Patient Positioning: Crucial specifics on patient positioning, and appropriate position of the arms and legs in a variety of positions (e.g., supine, prone, lateral, semi-prone).
  • Respiration: Instructions on suspending respiration at different points in the respiratory cycle to minimize movement blur.
  • CR Angulation: Guidance on angling the central ray (CR) in various projections to accurately target the relevant anatomical areas.
  • Centering: Procedures for accurately centering the image receptor (IR) in relation to the area of interest on all body parts.
  • Shielding: The importance of shielding surrounding tissues from radiation exposure.
  • Imaging Receptor Size: Instructions on varying the image receptor (IR) size in order to highlight specific details and anatomical regions.

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